Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2019; 25(47): 6857-6865
Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6857
Direct costs of carcinoid syndrome diarrhea among adults in the United States
Arvind Dasari, Vijay N Joish, Raul Perez-Olle, Samyukta Dharba, Kavitha Balaji, Daniel M Halperin
Arvind Dasari, Daniel M Halperin, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Vijay N Joish, Raul Perez-Olle, Samyukta Dharba, Kavitha Balaji, Lexicon Pharmaceuticals, Inc., The Woodlands, TX 77381, United States
Author contributions: Dasari A, Joish VN, Perez-Olle R, Dharba S, Balaji K and Halperin DM designed the research; Joish VN and Dharba S analyzed the data; Frimpter J wrote the paper and Dasari A, Joish VN, Perez-Olle R, Dharba S, Balaji K and Halperin DM critically revised all aspects of the manuscript and approved the final version for submission.
Institutional review board statement: We conducted a retrospective cohort study using the IBM® MarketScan® Database, a commercial health insurance claims database for employer-insured beneficiaries in the United States. The database is fully compliant with the Health Insurance Portability and Accountability Act and meets the criteria for a limited-use dataset. Since the patient and provider data included in this analysis were fully de-identified, this study was exempt from the Institutional Review Board review.
Informed consent statement: This study involved analyses of a Health Insurance Portability and Accountability Act-compliant secondary database, the IBM® MarketScan® Database, thus no informed consent was feasible or required.
Conflict-of-interest statement: This study was sponsored by Lexicon Pharmaceuticals, Inc., 8800 Technology Forest Place, The Woodlands, TX 77381, United States. Vijay N Joish, Samkyuta Dharba and Kavitha Balaji are employees of Lexicon Pharmaceuticals, Inc., and Raul Perez-Olle was an employee of Lexicon Pharmaceuticals, Inc. during the conduct of the study and development of the manuscript; they may own common stock or may have been granted stock options or other equity incentive awards. Arvind Dasari and Daniel M Halperin are employees of The University of Texas MD Anderson Cancer Center who received consulting fees from Lexicon Pharmaceuticals, Inc. for their participation and contributions to this study.
Data sharing statement: The statistician for this study, Samyukta Dharba, conducted all statistical analyses using a Health Insurance Portability and Accountability Act-compliant secondary database, the IBM® MarketScan® Database.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vijay N Joish, PhD, Executive Director, Epidemiology and Outcomes Research, Lexicon Pharmaceuticals, Inc., 110 Allen Road, Basking Ridge, NJ 07920, United States. vjoish@lexpharma.com
Telephone: +1-908-3604782
Received: June 15, 2019
Peer-review started: June 17, 2019
First decision: August 3, 2019
Revised: November 20, 2019
Accepted: November 23, 2019
Article in press: November 23, 2019
Published online: December 21, 2019

The burden of carcinoid syndrome (CS) among patients with neuroendocrine tumors is substantial and has been shown to result in increased healthcare resource use and costs. The incremental burden of CS diarrhea (CSD) is less well understood, particularly among working age adults who make up a large proportion of the population of patients with CS.


To estimate the direct medical costs of CSD to a self-insured employer in the United States.


CS patients with and without CSD were identified in the IBM® MarketScan® Database, including the Medicare Supplemental Coordination of Benefits database. Eligible patients had ≥ 1 medical claim for CS with continuous health plan enrollment for ≥ 12 mo prior to their first CS diagnosis and for ≥ 30 d after, no claims for acromegaly, and no clinical trial participation during the study period (2014-2016). Baseline demographic and clinical characteristics, including comorbidities and treatment, were analyzed using descriptive statistics. Measures of healthcare resource use and costs were compared between patients with and without CSD, including Emergency Department (ED) visits, hospital admissions and length of stay, physician office visits, outpatient services, and prescription claims, using univariate and multivariate analyses to evaluate associations of CSD with healthcare resource use and costs, controlling for baseline characteristics.


Overall, 6855 patients with CS were identified of which 4,043 were eligible for the analysis (1352 with CSD, 2691 with CS only). Baseline demographic and clinical characteristics were similar between groups with the exception of age, underlying tumor type, and health insurance plan. Patients with CSD were older, had more comorbidities, and received more somatostatin analog therapy at baseline. Patients with CSD required greater use of healthcare resources and incurred higher costs than their peers without CSD, including hospitalizations (44% vs 25%) and ED visits (55% vs 31%). The total adjusted annual healthcare costs per patient were 50% higher (+ $23865) among those with CSD, driven by outpatient services (+ 56%), prescriptions (+ 48%), ED visits (+ 26%), physician office visits (+ 21%), and hospital admissions (+ 11%).


The economic burden of CSD is greater than that of CS alone among insured working age adults in the United States, which may benefit from timely diagnosis and management.

Keywords: Carcinoid syndrome, Carcinoid syndrome diarrhea, Healthcare costs, Neuroendocrine tumors

Core tip: Healthcare resource use and costs among patients with carcinoid syndrome (CS) are known to be high, but the incremental burden of CS diarrhea (CSD) is less well understood. We analyzed insured, working age CS patients with and without CSD using the MarketScan® database (2014-2016) and observed a greater economic burden in the presence of CSD. Patients with CSD required more healthcare resources than their peers without CSD, including hospitalizations (44% vs 25%) and Emergency Department visits (55% vs 31%). Total adjusted mean annual costs per patient were 50% higher (+ $25865), driven largely by the use of more outpatient services (+56%).